TRAPEZIECTOMY

CASE STUDY
Ryann Bizette
ROOT CAUSE OF PROCEDURE:
THUMB ARTHRITIS
CAUSES/AT RISK:
Age
Overuse (job related, etc.)
Previous injury to joint
Obesity
RA
What occurs in thumb arthritis?
Cartilage covering the ends of the bones acting as a
cushion that allows for smooth pain-free movement
is very thin and deteriorating.
Causes friction, joint damage and in some cases -
bone spurs.
Results of thumb arthritis:
Stiffness
Swelling
Pain
Decreased ROM/Strength (fine and gross)
Decreased functional use of hand
 in this case, the affected bone is the trapezium carpal bone. This is typically
due to arthritis. In the surgical procedure, the trapezium bone is removed.

In the procedure, the Flexor Carpi Radialis is suspended down through the 1st

ANATOMY metacarpal

DETAILS
The Flexor Carpi Radialis originates from the medial epicondyle of the
humerus and inserts on the base of the second and third metacarpal. It is
innervated by the median nerve. It allows wrist flexion and assists in
abduction of hand/wrist.

FLEXOR CARPI RADIALIS MUSCLE

TRAPEZIUM CARPAL BONE

Image from: https://www.handsurgeryresource.org/taxonomy/term/279

image from: https://www.earthslab.com/anatomy/bones-of-the-hand-carpals-metacarpals-and-

phalanges/
 Removal of bone
The trapezium bone is removed
from the carpal space. In some
cases it is filled with a implant.
PROCEDURE
The trapezium bone is directly
DETAILS
under the thumb metacarpal.
Bone spurs are also removed if
any are present.
Tendon Graft
The Flexor Carpi Radialis is
pulled through drilled hole in
1st MC and the remaining is
coiled into the space where the
trapizum bone was located.
Procedure typically
takes 30 minutes
There is an incision on
the base of the lateral
volar wrist and middle
volar portion of the
forearm
You are not to move the
MP or CMC joint of
thumb (only the IP) until
four weeks post-op.
It may take 6-9 months
to fully recover and
regain fine and gross
motor strength.
 Anti-Inflammatory
Medications

Injections

CONSERVATIVE Splinting/Immobilizing

TREATMENT the joint

OPTIONS Occupational
Therapy/Physical Therapy
Adaptive equipment to reduce over use
of thumb
Dycem for opening jars, etc.
Introducing some life style adjustments
like advising less gripping (with grocery
bags, etc.), breaks at work, and so on.
Introducing gentle fine motor activities
(in hand manipulation)
Gentle AROM stretches
Modalities (heat and cold)
 EVALUATION DATE (3-5 days post-
op)
Removal of bulky dressing, clean incision
site, redress site with appropriate
dressing/compression sleeve/thumb sock
Measure ROM (wrist flex/ext, UD/RD; check
composite flexion of fingers)
Fabricate thumb spica splint
Gentle AROM of wrist, fingers and IP of
thumb.

PROTOCOL
NO movement of CMC or MP of thumb...
only IP of thumb.
FOUR WEEKS
Initiate AROM of flexion for thumb
Encourage light ADLs.

SIX WEEKS
Can begin to initiate AAROM/PROM of
thumb
Splint d/c by MD

SEVEN/EIGHT WEEKS
Begin to initiate strengthening exercises
 ORTHOTIC FABRICATION FOR
TRAPEZIECTOMY -
THUMB SPICA SPLINT

Keep the Thumb IP free

Measure the width of the
thumb
Measure from tip of
fingers down forearm.
EVIDENCE BASED SUPPORT
ARTICLE:
What Are the Patient-reported
Outcomes of Trapeziectomy and
Tendon Suspension at Long-
term Follow-up?

POPULATION: 96 Patients with

Trapeziectomy and APL
suspension; 89 woman, 7 men

Pt’s utilized a pain scale

questionnaire ranging from 0-
100. Mean score for thumb pain
following at least week 6 of
therapy was approx 19.

CONCLUSION: Post-op, patients

have experienced a general
decrease in pain. What is not
known is the longevity/how
durable the surgical revision is
years later.
OCCUPATIONAL PROFILE
75 y.o. RHD male
Surgery Date 1/23/24
Procedure on R thumb due to years of intense
pain and arthritis in wrist/thumb; pain was so
intense that he could not brush his teeth.
Pt is married and lives at home with his wife. He is
retired.
He enjoys being on his sailboat and hanging with
his grandchildren. He enjoys sporting events.
PMH: HBP, Cancer, arthritis, past R RF DIP fused.
 Client/Caregiver Goals
Pt will be able to use his R hand to perform all ADLs and IADL tasks
without limitation by 3/13/24.
STG’s
Pt will be educated in HEP by 1/29/24 - MET
Pt will verbalize and/or demonstrate understanding of HEP designed to
promote increased tissue length, strength, and pumping mechanism

TREATMENT
of lymphatic and venous systems by 1/29/24 - MET
Pt will increase R thumb IP flexion to 70 degrees to increase

GOALS independence in ADLs by 2/12/24

Pt will increase R wrist flexion to 50 degrees to increase independence
in ADLs by 2/12/24.
Pt will increase R wrist extension to 50 degrees to increase
independence in ADLs by 2/12/24.
Pt will increase R radial deviation to 30 degrees to increase
independence in ADLs by 2/12/24.
Pt will increase R ulnar deviation to 40 degrees to increase
independence in ADLs by 2/12/24.
LTG’s
Pt will demonstrate improved hand strength to be able to work on his
sail boat by 3/13/24.
Pt will demonstrate hand function sufficient to complete ADLs, such as
grasping and pulling on socks, shoes and pants by 3/13/23.
CLIENT’S PROGRESS
Week 2-3: Pt has wrist and digit motion WFL. Thumb IP motion moving well. Minimal complaints of
pain. Pt’s stiches were removed at week 2. Scar is healing well and flattening out.

Week 4: Pt with significant edema still in thenar eminence. Isotoner glove was issued to client to
decrease swelling. Pt began initiating active thumb flexion at MP joint.
IP flexion was 35 degrees , MP flexion was 20 degrees
End of week 4: Pt’s swelling in thenar eminence has decreased. The thumb is progressing well with
active composite flexion/extension. He reports he was able to feed himself with his R hand last
night.
IP flexion 45 degrees, MP flexion 30 degrees.

Week 5: Thumb, wrist and digit motion is progressing well. There is minimal complaints of pain or
tightness. Remolded pt’s splint with silicone gel pad on scar to decrease friction on scar area
located on lateral dorsal thumb. Reminded pt to be patient during this process of healing and
regaining function. Pt reported he can now button his pants on his own!

REEVAL: refer to next slide for information

CLIENT’S PROGRESS- REEVALUATION
2/29/24 - 1 month since evaluation; 5 weeks post-op.
ROM measurements:
Wrist:
Flexion 42 - Gained 12 degrees since evaluation
Extension 62 - GOAL MET
UD 27 - Gained 4 degrees since evaluation
RD 20 - Remained consistent with evaluation measurement.
Thumb:
IP 55 - gained 15 degrees since evaluation
MP 46 - (first measurement); MP goal set at 64.
He reports he is now able to get dressed and button his pants independently with
his R hand. He reports that he is still unable to carry a shopping bag with R hand.
He has improved from being unable to participate to having mild difficulty during
tasks like laundering clothes and getting dressed.
CLIENT’S PROGRESS CONT. WEEK
6-7
Week 6: Pt d/c from TSS. Pt’s thenar eminence still with moderate edema
present hindering flexion in thumb. Pt educated to continue wearing isotoner
glove.
Gave pt therapeutic activity of foam peg board with pegs to assist in
utilizing flexion and opposition of R thumb. Pt tolerated this well with no
complaints of pain or fatigue.

Week 7: Began initiating light pinch/grip strengthening activities like hand

helper with resistance bands to pick up foam cubes and lateral key turns on a
velcro board. Began LLPS via wrapping thumb down in paraffin. Tried joint
mobilization to MP and IP to increase thumb flexion.
Pt reports that he has been able to open his door now with little difficulty.
Thumb IP flexion 55 degrees; thumb MP flexion 50 degrees
 RESOURCES
Cannon, N. M. (2020). Diagnosis and treatment manual for physicians & therapists: Upper extremity treatment
guidelines. Hand Rehabilitation Center of Indiana

Dpt, K. G. P. (2024, January 29). Trapeziectomy: everything you need to know. Verywell Health.
https://www.verywellhealth.com/trapeziectomy-5089757

Flexor carpi radialis muscle. (2023, November 3). Kenhub.

https://www.kenhub.com/en/library/anatomy/flexor-carpi-radialis-muscle

Thumb arthritis - Symptoms and causes - Mayo Clinic. (2022, June 16). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/thumb-arthritis/symptoms-causes/syc-20378339

Wolf, J. M., Turkiewicz, A., Englund, M., Karlsson, J., Arner, M., & Atroshi, I. (2021). What Are the Patient-reported
Outcomes of Trapeziectomy and Tendon Suspension at Long-term Follow-up?. Clinical orthopaedics and related
research, 479(9), 2009–2018. https://doi.org/10.1097/CORR.0000000000001795